Pulmonary Disease Signs & Symptoms Quiz

Signs & Symptoms of Pulmonary Disease

• Dyspnea (most common): breathing discomfort
  • Orthopnea: dyspnea that occurs when an individual lays flat; often seen in heart failure
• Cough (most common): protective reflex to clear airways
• Abnormal sputum: changes in amount, color, and consistency (always culture!)
  • Hemoptysis: coughing up of blood or bloody secretions
  • Empyema: pus in the pleural space of the lungs
• Abnormal breathing patterns: changes in breathing effort
  • Kussmaul respirations: deep, rapid, and labored breathing (seen in diabetic ketoacidosis)
  • Cheyne-Stokes respirations: alternating periods of deep and shallow breathing with apnea between; common in individuals actively dying

Hypoventilation & Hyperventilation

• Hypoventilation: Inadequate alveolar ventilation; often seen in drug overdose
• Hyperventilation: Alveolar ventilation exceeds metabolic demands; too much CO2 being expelled
• Cyanosis: Bluish discoloration of skin & mucous membranes due to desaturated hemoglobin; not always present in a deoxygenated state
• Clubbing: Bulbous enlargement of digit ends; associated with chronic hypoxemia (e.g., bronchiectasis, cystic fibrosis, pulmonary fibrosis)

Restrictive Lung Diseases

• Difficulty getting air into the lungs
• Decreased compliance: more effort to expand the lungs

Bronchiolitis

• Diffuse, inflammatory obstruction of small airways; common in children

Pulmonary Fibrosis

• Excessive fibrous tissue in the lung; can be idiopathic or caused by scar tissue after lung disease, autoimmune disorders, or irradiation
• Marked loss of compliance

Inhalation Disorders

• Exposure to toxic substances
• Dust particles, asbestos, and coal are common causes (AKA Coal Miners Disease)
• Hypersensitivity pneumonitis

Acute Lung Injury (ALI) & Acute Respiratory Distress Syndrome (ARDS)

• Acute Lung Inflammation and Diffuse Alveolocapillary Injury
• Diagnosed by history, exam, blood gases, and CXR.
• Three phases:
  • Exudative (within 72 hours): Damage to endothelial cells causes capillary membrane permeability; fluids leak into interstitium and alveoli; lower compliance, decreased tidal volume, and hypercapnia; acute respiratory failure.
  • Proliferative (within 4-21 days): Diffusion barrier forms, resulting in progressive hypoxemia.
  • Fibrotic (within 14-21 days): Remodeling and fibrosis of lung tissue; potential for long-term respiratory compromise.

ARDS Manifestations

• Dyspnea
• Hypoxemia
• Hyperventilation/Hypoventilation
• Poor tissue perfusion
• Respiratory failure, poor cardiac output, hypotension, death

ARDS Supportive Therapy

• Focused on maintaining adequate oxygenation and ventilation while preventing infection; often requires mechanical ventilation
• GOAL IS OXYGENATION!

ARDS Positioning

• Frequent position changes with the "good lung down"
• Head of bed elevated 30 degrees
• Prone positioning improves gas exchange

ARDS Causes

• Aspiration, inhalation injury, sepsis, embolism, pneumonia, trauma

Obstructive Lung Diseases

• Impaired ventilation and oxygenation
• Airway obstruction worse with expiration
• Common signs and symptoms: dyspnea and wheezing

Common Obstructive Disorders

• Asthma
• COPD
• Emphysema
• Chronic bronchitis

Asthma

• Chronic airway inflammation; antigen initiates innate and adaptive immune responses in sensitized individuals
• Very common in children
• Manifestations:
  • Wheezing on exhalation (high-pitched sound in upper lobes)
  • SOB
  • Chest constriction
  • Tachycardia/tachypnea
  • Excessive accessory muscle use

Asthma Treatment

• Avoidance of allergens and irritants
• Low-dose corticosteroids and short-acting beta-agonist inhalers
• Anti-inflammatory medications for severe cases
• Immunotherapy

Chronic Obstructive Pulmonary Disease (COPD)

• Persistent airflow limitation; progressive; most common lung disease worldwide; 4th leading cause of death globally
• Combination of chronic emphysema and bronchitis
• Risk factors:
  • Tobacco smoke
  • Occupational dusts/chemicals
  • Air pollution
  • Factors affecting lung growth during fetal development and childhood (e.g., low birth weight, respiratory tract infections)

Chronic Bronchitis

• Hypersecretion of mucus and chronic productive cough lasting for at least 3 months of the year for at least 2 consecutive years
• Inspired irritants increase mucus production and the size and number of mucous glands
• Mucus produced is thick
• Cilia is gone or ineffective, unable to clear mucus

Chronic Bronchitis Treatment

• Prevention is key: Stop smoking to halt disease progression
• Bronchodilators, mucolytics, antioxidants, and anti-inflammatory drugs
• Physical therapy (deep breathing and postural drainage)
• Acute exacerbations: antibiotics and corticosteroids; may require mechanical ventilation

Chronic Bronchitis Manifestations

• Productive cough
• Dyspnea
• Wheezing
• Prolonged expiration
• Cyanosis
• Chronic hypoventilation
• Polycythemia
• Cor pulmonale

Emphysema

• Abnormal and permanent enlargement of gas-exchange airways with destruction of alveolar walls (no fibrosis)
• Primary emphysema (1%-3% of cases) is linked to an inherited deficiency of alpha 1-antitrypsin
• Loss of elastic recoil causes air trapping, leading to hyperexpansion of the chest (barrel chest) and increased work of breathing
• Individuals often purse their lips to help get air in

Emphysema Manifestations

• Dyspnea
• Wheezing
• Barrel chest
• Prolonged expiration

Tuberculosis

• Infection caused by Mycobacterium tuberculosis, usually affecting the lungs
• Highly contagious and airborne; can result in latent TB infection
• Bacteria may lodge in lymph, initiating an immune response
• Diagnosed via TB skin test
• Abscesses can destroy lymph tissue and cause cavitation when they empty into bronchi
• Treated with antibiotics

Pulmonary Embolism

• Thrombus: stationary clot
• Emboli: traveling clot through the blood
• Thromboemboli: dislodged thrombus traveling
• Occlusion of a part of the pulmonary vascular bed by a thrombus, embolus, tissue fragment, lipids, or air bubble
• Commonly arise from deep veins in the legs (ambulation is important after surgery!)
• Virchow triad: venous stasis, hypercoagulability, and injuries to endothelial cells

Pulmonary Artery Hypertension (PAH)

• Mean pulmonary artery pressure 5-10 mmHg above normal or above 20 mmHg
• Respiratory system diseases and hypoxemia are most common causes
• May not be detected until severe
• Manifestations:
  • Fatigue
  • Chest discomfort
  • Tachypnea
  • Dyspnea (particularly with exercise)
  • Peripheral edema, JVD, accentuation of the pulmonary component of the second heart sound

Cor Pulmonale

• Pulmonary heart disease; right ventricular enlargement
• Develops as PAH exerts chronic pressure overload in the right ventricle, causing hypertrophy and ultimately failure
• Goal of treatment is to reduce workload of the right ventricle by lowering pulmonary artery pressure

Malignancies of the Respiratory Tract

• Lung (bronchogenic): most common cause is cigarette smoking
  • Heavy smokers have a 20-times greater risk of developing lung cancer than non-smokers
  • Smoking linked to cancers of the larynx, oral cavity, esophagus, and urinary bladder
  • Environmental and occupational risk factors can also contribute
  • Clinical manifestations listed in Table 29.3
• Non-small cell is most common: squamous cell carcinoma, adenocarcinoma, large cell carcinoma
• Small cell: from neuroendocrine tissue

Test your knowledge on the signs and symptoms of various pulmonary diseases. This quiz covers critical concepts such as dyspnea, cough, abnormal sputum, and breathing patterns. Understand the implications of hypoventilation and hyperventilation in respiratory health.